5.8 OUTPATIENT HOSPITAL SERVICES
Covered Expenses for services provided by a Hospital on an outpatient basis include:
- Diagnostic laboratory examinations, chemotherapy, diagnostic x-rays, radium or radioactive isotope therapy;
- Outpatient hemodialysis, radiation therapy, and chemotherapy;
- Surgical procedure(s) performed in the outpatient department; and
- Medically Necessary Hospital services for the removal of impacted teeth or the removal of a dental root without extraction of an entire tooth. Covered Dental Expenses related to charges from a dentist or oral surgeon are paid under dental care benefits.
Certain surgical services have limited coverage if precertification is not obtained or if services are obtained at a non-Preferred Provider facility, as described in the following Section “Surgical Services.”
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